Post-transplant hepatic fibrosis in pediatric liver-small bowel transplant recipients: A single-center, retrospective, observational study
Hanh D Vo1, Stanley J Radio2, Emille M Reyes-Santiago1
1Pediatric Gastroenterology, Hepatology, and Nutrition, University of Nebraska Medical Center, Omaha, NE, USA.
Insights
Hepatic graft fibrosis prevalence is similar in liver-small bowel-stomach transplant (LSBT) and liver transplant (LT) children. However, predictors for fibrosis differ, with biliary complications in LT and AST/ALT ratio in LSBT patients.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Gastroenterology
Background:
- Hepatic graft fibrosis is a concern in pediatric liver transplant recipients.
- Limited data exists on hepatic graft fibrosis prevalence in combined liver-small bowel-stomach transplant (LSBT) pediatric patients.
- Understanding fibrosis predictors is crucial for post-transplant management.
Purpose of the Study:
- To determine the prevalence of hepatic graft fibrosis in children undergoing LSBT.
- To identify predictors of hepatic graft fibrosis in LSBT recipients.
- To compare fibrosis prevalence and predictors between LSBT and traditional liver transplant (LT) recipients.
Main Methods:
- Retrospective analysis of pediatric patients (<19 years) undergoing primary LT or LSBT between 2000-2018.
- Inclusion criteria required liver biopsy at least 6 months post-transplant.
- Cox proportional hazards regression used to identify predictors of significant fibrosis (≥F2).
Main Results:
- Ninety-six children (47 LSBT) were analyzed; fibrosis prevalence was 70.2% in LSBT vs. 81.6% in LT recipients (p=0.19).
- Post-transplant biliary complications predicted fibrosis in LT children.
- AST/ALT ratio predicted significant hepatic graft fibrosis in LSBT children.
Conclusions:
- Hepatic graft fibrosis prevalence is comparable between pediatric LSBT and LT recipients.
- Predictors for hepatic graft fibrosis appear to differ between LSBT and LT.
- Further research is needed on autoimmune and donor-specific antibodies in LSBT fibrosis progression.
Background:
Little is known about the prevalence of hepatic graft fibrosis in combined LSBT children. We aimed to determine the prevalence of and identify potential predictors for hepatic graft fibrosis in LSBT children and to compare them with those in LT children.
Methods:
We retrospectively included children younger than 19 years who had received a primary LT/LSBT between 2000 and 2018 and had a liver biopsy performed at least 6 months post-transplant. A Cox proportional hazards regression model was used to determine predictors associated with significant hepatic graft fibrosis (≥F2) in LSBT vs LT children.
Results:
Ninety-six children (47 LSBT, 54 females) were included. The median post-transplant follow-up (years) was 12.8 in LT vs 10.5 in LSBT patients (P = .06). Hepatic graft fibrosis was found in 81.6% of LT vs 70.2% of LSBT children (P = .19), after a median time of 2.5 years and 2.6 years, respectively. On multivariate analyses, having post-transplant biliary complications was found to be associated with significant graft fibrosis in LT children, whereas AST/ALT ratio was found to predict significant hepatic graft fibrosis in LSBT children. The use of parenteral nutrition after transplant was not associated with significant hepatic graft fibrosis.
Conclusions:
The prevalence of hepatic graft fibrosis in LSBT children did not significantly differ from that in LT children, but the predictors may differ. Future studies should investigate the role of post-transplant autoimmune antibodies and donor-specific antibodies in the development and progression of hepatic graft fibrosis in LSBT children.
